The EU Directive on Cross Border Healthcare is making it's way through the labyrinth of British government. Slow progress, but it's progress towards a European market in healthcare.

The House of Lords EU Committee have welcomed the proposal from the European Commission for a Directive on patients' rights to cross-border healthcare. The Committee has called for improvements and has warned that, due to the unpredictable impact of the provisions in the Directive, it must be carefully monitored upon implementation.

The Committee has agreed with the Commission that, as the right of EU citizens to travel to another Member State to receive healthcare has been confirmed by the European Court of Justice over the last ten years, it is essential to put in place a legal framework to replace the current ad hoc arrangements.

The Committee also considered whether patients seeking healthcare in other European Member States should pay the costs themselves in advance of treatment and then claim reimbursement later. They have raised concerns that this would prevent those without adequate financial means from taking advantage of their right to cross-border healthcare. The Committee's report recommends that a patient's own healthcare provider should pay the fees directly to the provider in the other Member State, and suggests that this could be linked with the process of securing authorisation prior to travel, which the Committee considers necessary both in order to protect the financial resources of health systems and to enable patients to make informed decisions about their treatment.

The report also calls on Member States to ensure that patients are aware of their rights under the Directive and are informed about the quality of care that they can expect, any potential language barriers, and how to make a complaint should that be necessary. Member States should finance information for its own citizens about healthcare abroad and should draw up a description of its own health system to guide other Member States. Acknowledging that it may fall to medical practitioners, such as GPs and dentists, to actually provide the information to patients, the Committee argue that the Directive should avoid the imposition of any administrative burden on healthcare professionals.

The Committee have also called for greater clarity on systems of redress when patients are dissatisfied with, or harmed by, healthcare provided in another Member State.The Committee welcome the Directive's provision that a Member State would be able to refuse to accept a patient from another Member State if, for example, this would increase waiting times for treatment. Nevertheless, they recommend that this part of the Directive would benefit from some strengthening.

Finally, the Committee emphasise that the impact of the Directive will only be clear once it has been implemented, and so recommend that it be reviewed within three years, rather than five as proposed by the Commission.

According to our Medical Tourism Survey in 2008, around a third of UK medical tourists make their arrangements through a medical tourism facilitator. In some countries, such facilitators account for an even greater share of the market, and their influence is growing. The concern of many is the uncontrolled growth of the sector and the lack of regulation within it.

Let's say that I want to start a medical tourism facilitation business. How easy is it?

What do I need?

I need a name. I'll call my business "Magical Medical Travels".

I need a telephone. I've got one of those.

I need an internet connection. I've got one of those.

I need a web site to generate some patients. I can create something that will do the job, using a cheap package such as 1&1 web hosting.

I need some hospitals and clinics overseas that are prepared to pay me a commission, if I send patients to them. I'm sure that I can find a few of those.

I suppose I need to find someone in the destination country who can look after the patients while they are there.

....and maybe some documents that I can get the patient to sign.

Oh, and it might be a good idea to invent a few patient testimonials...

Do I need to be medically qualified? Well, I'm known as Dr Pollard on several internet forums, and I have some drpollard@ email addresses, so that should be fine.

Cash flow. Well, if I take money up front from patients, and then pay the treatment providers late, that's not a problem. I'll buy some online advertising, and leave it a few months before paying the bill.

I'll pay a few hundred pounds to join one of the medical travel associations; that will give me some credibility.

It's pretty easy really? And that's how some (not all!) medical tourism facilitators have come about. Medical tourism is a very fragmented market and there's a pretty wide range of facilitators in the business.

Which brings me back to the title of this blog: "When is a medical tourism facilitator a medical travel agent?"

In the UK and Europe, that's actually quite an important question. Let's expand the question...

"What's the difference between a medical tourism facilitator who sells a consumer a package of accommodation, travel and treatment and a regular travel agent who sells a consumer a package of accommodation, travel and related holiday activities?".

In the UK, the activities of travel agents are highly regulated. For example, the "Package Travel, Package Holidays and Package Tours Regulations" were introduced to protect consumers from unscrupulous travel agents. A package is defined as the "pre-arranged combination of at least two of the following components - transport, accommodation, other tourist services".

So, is a medical tourism facilitator a travel agent? Some would say...yes!

And if that's the case, the Package Travel Regulations come into force and my new facilitation company, Magical Medical Travels might have some problems. It means my company will be subject to controls over:

What I can say in my brochure or web site.

The nature of any contracts I make.

The information I provide to the consumer.

Changes in price.

Security in the event of insolvency. ie. I will need to be bonded.

With regard to the latter, when someone books a holiday in the UK, many will look to see if the travel company is ABTA (Association of British Travel Agents) bonded. Which means that the company has placed a bond with an authorised institution, based on their turnover. The minimum bond is £20,000.

Even if you pay the bond, you can't join ABTA, unless you comply with their Code of Conduct, and submit to random inspection.

In the perfect world, we need an ABTA of the medical travel world - properly funded, run by a truly representative Board of Directors, that is answerable to its membership, that publishes an annual report and financial statements, that only accepts members who meet clearly defined criteria, that inspects member premises at random, and that requires all members to place a significant bond for the protection of medical travellers.

Likely?

I doubt it.

What is more likely....

As medical travel grows, especially in a background of government driven initiatives such as the European Directive on Cross Border Healthcare, governments will begin to regulate medical travel facilitators and agents. Bodies such as ABTA in the UK and similar organisations in other countries would probably favour and support this.

"What makes a medical travel agent any different and exempt from regulation?", they would say.